Pit and Fissure Sealants in the Prevention of Dental Caries in ...

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––– Sealants: Prevention of Caries ––– Citation: Staninec M, Artiga N, Gansky SA, Marshall GW, Eakle S. Bonded amalgam sealants and adhesive resin sealants: five-year clinical results. Quintessence Int 2004; 35(5):351–7. Population: 26 patients needing at least 2 sealants on permanent posterior teeth (total of 116 teeth) • Age: 6–25 years • Sex: Not mentioned • Location: University of California in San Francisco; research environment unclear • Representative of patients 6–25 years of age Intervention: • n = 37, molar amalgam sealant • n = 20, premolar amalgam sealant Control: • n = 36, molar resin sealant • n = 23, premolar resin sealant Outcomes: Clinical examinations at 6 months, 1 year, 2 years and 5 years • 42% loss to follow-up for patients (n = 15) at 5-year recall • 16% loss to follow-up for teeth (n = 97) No difference in retention for amalgam sealants (n = 47) vs. resin sealants (n = 48) • No loss: 26% vs. 30%, respectively • Slight loss: 34% vs. 32%, respectively • Repair required: 40% vs. 38%, respectively Failure rate for amalgam vs. resin sealants: • Repair required or total loss: odds ratio (OR) 1.15 (95% confidence interval [CI] 0.65–2.05, p = 0.62) • Worst category: OR 1.16 (95% CI 0.77–1.75; p = 0.47) • Hazard ratio for time to “repair required or total loss” 0.81 (95% CI 0.33–2.02; p = 0.65) Failure rate (molar vs. premolar): • Resealing OR 4.9 (p = 0.04) • Worst rating OR 5.6 (p = 0.02) • Hazard ratio 6.8 (p = 0.004) Caries development: none on any surface in either group Authors’ Conclusion: Although amalgam sealants may not be practical by themselves, they can be used to seal pits and fissures surrounding very conservative preparations, in the “preventive amalgam restoration.” Conventional amalgam retentive features and 90° cavosurface margins may not be necessary when bonding is used with amalgam. Critical Appraisal: • Amalgam sealants cost more than resin sealants • No randomization or placebo group • 42% loss to follow-up for subjects • No power calculation • No blinding of examiners • Mixed population (6–25 years of age) Level of Evidence, Grade of Recommendation and Score on “Checklist to Assess Evidence of Efficacy of Therapy or Prevention”: Level II-1; grade A for sealing teeth with amalgam sealants or resin-based sealants; score 11/16 JCDA • www.cda-adc.ca/jcda • March 2008, Vol. 74, No. 2 • App_183xix
––– Azarpazhooh ––– Citation: Yildiz E, Dorter C, Efes B, Koray F. A comparative study of two fissure sealants: a 2-year clinical follow-up. J Oral Rehabil 2004; 31(10):979–84. Population: 59 dental students • Age: 18–20 years • Sex: Not mentioned • Location: Department of operative dentistry, faculty of dentistry, Istanbul University, Capa, Istanbul, Turkey • Representative of young adult population Intervention: 122 fissures of first and second molars in 59 adults; fluoride-containing fissure sealants (Helioseal F) compared with conventional sealant (Concise Light Cure White Sealant) on first and second molars of right side of patient’s mouth (teeth 17, 16, 46 and 47) Control: 122 fissures of first and second molars in 59 adults: contralateral teeth on left side of each patient’s mouth used as controls (teeth 27, 26 36 and 37) Outcomes: Recall appointments scheduled at 3, 6, 12 and 24 months after placement. Retention: • Full retention: 72.1% after 3 months, 46.7% after 24 months (nonsignificant) • Total loss of Helioseal F (16.4%, 19.7%, 18% and 23% at 3, 6, 12 and 24 months, respectively) was more than total loss of Concise Light Cure White Sealant (8.2%, 9.8%, 11.5% and 18%, respectively) (nonsignificant difference between sealant materials for fully retained, partially lost and totally lost at any recall interval • Better retention on first molars than on second molars (statistically significant difference at 3, 6 and 12 months; nonsignificant at 24 months) • Better retention on the mandibular molars (nonsignificant) Caries development: • No caries detected at 3 and 6 months in any sealed tooth • Incidence of caries in teeth treated with Helioseal F vs. Concise Light Cure White Sealant was 11.5% vs. 0% at both 12-month and 24-month recalls (statistically significant) • Among teeth treated with Helioseal F, caries incidence for upper second molar was higher than for lower first molar teeth (statistically significant at both 12 and 24 months) • Sealed vs. nonsealed teeth at 12-months: 5.7% vs. 15.6% (statistically significant) • At 24 months, no change in the sealant group (5.7%), but a statistically significant increase in the control group (from 15.6% to 25.4%) • Highest caries incidence at 24 months: lower and upper second molar teeth among the unsealed control teeth (nonsignificant) Authors’ Conclusion: Based on the results of this study, the application of fissure sealants is highly effective in preventing caries in a young adult population, and the reduction of caries development is more related to the quality of sealant retention than to the content of the material. Critical Appraisal: • No blinding of examiners • No randomization (split-mouth model) • Care outside study was not identified or controlled for • No control for possible confounders: number of brushing sessions, diet, exposure to fluoride, etc. Level of Evidence, Grade of Recommendation and Score on “Checklist to Assess Evidence of Efficacy of Therapy or Prevention”: Level II-1; grade A for sealing teeth; score 11/16 App_183xx JCDA • www.cda-adc.ca/jcda • March 2008, Vol. 74, No. 2 •
Page 1 and 2: Clinical P r a c t i c e Pit and Fi
Page 3 and 4: --- Sealants: Prevention of Caries
Page 9 and 10: --- Azarpazhooh --- Citation: Beiru
Page 11 and 12: --- Azarpazhooh --- Authors’ Conc
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Page 39 and 40: --- Azarpazhooh --- Citation: Hamil
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